Concept and contents of a voluntary course for medical students' achievement of a basic qualification in patient safety during the practical year of medical studies

Objective: Regarding the urgent need of qualification in the field of patient safety, the respective education and training were completed by a voluntary course for 10-15 students in their practical year (PY) provided in cooperation of the private University Hospital of Marburg and the Medical Faculty of the Philipps-University of Marburg. At the same time, this course was intended to develop important knowledge for implementing improvements of the current PY teaching as well as revising the curriculum of Marburg in the medium term. Project description: The PY course on patient safety is offered every six months since 2016 and comprises about 80 lessons. It is based on the principles of shifting simple knowledge transfer to autonomous preparation by the students themselves, of revising already experienced situations of the professional routine, of working with real data of current patients of the PY students, of fostering teamwork, and of applying very deliberately a large combination of methods with numerous interactive types of teaching. The topics of those 13 course units include the majority of the most important problem categories of patient safety as reported in the literature such as communication, drug safety, diagnostic errors, and handovers as well as methods for systematic identification and analysis of errors. In the context of a project task, the students evaluate by means of the global trigger tool and 10 patient files of their current wards each if harm has occurred in the treatment of these patients. Afterwards, the students elaborate in teams of 2 a fishbone diagram for one case where an avoidable harm had emerged. In this graph, the deficient process, the factors contributing to its development, the safety measures that are already applied in the department as well as suggested improvements of the students are visualized. In the final lesson of the course, the students explain and describe their diagram to a member of the managing board of the university hospital. Successful participation is confirmed by an official certificate issued by the Medical Center for Quality in Medicine (Ärztliches Zentrum für Qualität in der Medizin) stating that the course meets the level II requirements (“Basic qualification”) of the training concept on “patient safety” of the Germany medical staff. Results: After meanwhile 5 episodes of this course, the whole curriculum obtained a mean score of “very good” based on the standard questionnaire of the Medical Faculty of the University of Marburg. The students perceive an enormous increase in competence regarding the implementation of specific projects to improve patient safety. Furthermore, the intensive cooperation with the PY students led to conceiving and establishing further 7 PY courses for the benefit of patient safety and consolidation of entrustable professional activities. In combination with experiences gained elsewhere from courses on patient safety, the collected knowledge could be used for a first draft of teaching and education of patient safety during the entire clinical studies that takes into account the local conditions. Conclusion: In the process of anchoring the topic of patient safety in the Marburg curriculum of medical studies, the introduction of an extensive voluntary course in the second four months of the clinical internship (practical year) turned out to have a very positive effect. Supported by the management board of the hospital and the medical faculty, we consider it useful to permanently provide such an extensive course for a group of students who want to early and intensively deal with the topic of patient safety.

 has studied patients' and relatives' reports and understood their experiencing of incorrect procedures as well as their wish that the organization learns from those incidents and reacts appropriately with regard to further caregiving  knows about typical conflicts in the communication with people of a higher hierarchic level as well as the nursing staff and has discussed suitable strategies or promising behaviors  knows important coping strategies regarding severe treatment complications as well as behavior strategies in case of harm  knows important safety strategies from aviation as well as an outstanding patient safety project in an English hospital and is able to discuss the transferability of these strategies on the situation in German hospitals  has participated in a morbidity and mortality conference of the own department and learned about the professional handling of unfavorable procedures  knows about an established method that enables people to systematically analyze incorrect processes in healthcare management  knows the approach of prospective clinical surveillance and has applied it in the context of patients' files of the own department  is able to analyze patients' files by means of the global trigger tool in view of significant warning signals regarding patient safety, to identify and classify patient harm, and to critically rate the results *  has identified one incorrect process in the own department by means of the global trigger tool, analyzed it in a team, and visualized the result of this analysis in form of a fishbone diagram including own suggestions for improvement *  has presented the analysis of an incorrect process in the own department to experienced physicians of the university hospital and discussed it including own suggestions for improvement *  has identified and noted numerous circumstances that jeopardize the patient safety in a small team under time pressure in a "room of horror" based on a simulated patient's performance *  has submitted in the final course unit one own specific proposal to increase patient safety to a member of the managing board of the university hospital *

Introduction and e-learning phase
The student  knows the results of the most important international trials on patient safety and is able to estimate the significance of these results for the situation in German hospitals  knows relevant basic terms to understand the international literature on patient safety and to contribute to projects to improve patient safety  knows the basic terms and concepts of failure management and successful teamwork  has analyzed a video clip of a reanimation situation in a small team with regard to incorrect and suboptimal processes and has submitted suitable suggestions for improvement *

Drug safety
The student  knows relevant facts of drug safety as well as numerous actors, processes, failure and improvement possibilities that are involved  knows the FORTA list (Fit fOR The Aged) and knows how it may be applied to optimize medication of own high-risk patients  has evaluated the medication of multimorbid patients of the own ward containing at least six different substances by means of three types of specialized computer software (for application in general practices and hospitals as well as patients with severely impaired renal function) with regard to potentially severe undesired drug effects and discussed his/her results with two experts (clinical pharmacologist, internist) *  knows the problems of frequently false-positive warning signals of software with regard to possible undesired drug effects

Communication
The student

Diagnostic errors
The student  knows different types of diagnostic errors and strategies to cope with those failures  has assigned the events of real cases to different failure types  has participated in role plays on diagnostic errors in a teaching ward with simulated patients assuming the role of the physician or as observer and has experienced or observed and analyzed typical sources of error *  has installed suitable software on the own notebook or smartphone to reduce diagnostic errors, has tested the benefit of the software based on given case reports, is able to apply this software to optimize caregiving to own patients

Handover and release management
The student  knows different suitable checklists for handover in medical care as well as release management and is able to appropriately apply the ISOBAR scheme in the context of handover *  has documented the handover scheme in the own department and if possible submitted a respective suggestion for improvement *  has participated in role plays of different handover situations in teaching wards with simulated patients in the role of physician or as observer and has experienced or observed and analyzed typical error sources in this context *  has participated in a role play on follow-up care by general practitioners after an inpatient stay in a teaching practice with simulated patients in the role of the physician or as observer and has experienced or observed and analyzed typical error sources in this context *

CIRS (Critical Incident Reporting System)
The student  knows different medical CIR systems that are applied in Germany including the system used at the own hospital  has analyzed real reports from a medical CIRS in a small team, has elaborated suggestions for improvement and justified them to a CIRS ombudsman of the university hospital *

Handling severe treatment complications and stressful courses
The student  has reported about own experiences or events that have been told with stressful courses as well as the respective coping strategies and/or dealt with examples from the professional life of a very experienced physician  has acquired knowledge about a specific aid programs for staff members of the own hospital to handle severe treatment complications/stressful courses and the coping strategies  knows the most important strategies to cope with such situations, is able to interpret the symptoms and to suggest or apply appropriate and suitable strategies for the further procedure, if needed  has dealt with coping strategies shown in a video regarding severe treatment complications or stressful courses of a physician

Rules of conduct in cases of harm
The student  has acquired knowledge about the feelings and emotions of patients and their relatives after medical failures and errors as well as the patients' and relatives' wishes about the further procedures after this failure, based on an instruction video with interviews  has participated in role plays to interact with upset relatives as well as with police officers in a teaching ward in the role of the physician or as observer and experienced or observed and analyzed advisable behaviors *  has analyzed in a team incorrect processes shown in an episode of Grey's Anatomy that led to the avoidable death of a patient, has visualized them based on a compiled fishbone diagram and given recommendations to increase the patient safety in the described environment *